Well, I survived my birding trip to Bolivia! Thank you for your support before I went away, when I was having a wobble about the health insurance. Apologies that I did not acknowledge some of your comments, as I was already on my journey. Anyway, nothing terrible happened and, in fact, I feel more well than I have done in 2 or 3 years. I increased my pred from 5mg to 6mg about 10 days before I went to help me get through it, so I am not sure if it is the increased dose, or the fresh air, sunshine, extra walking, and doing something that I love for 3 weeks that has contributed to my current sense of wellbeing. Plus, I have lost a few lbs while I was away, as I always do at high altitude, and I am close to my pre pred weight again.
Anyway, the reason for the post is that several people have asked about the effects of altitude with PMR over the last few months and I promised to report back on my return. A disclaimer that the following are my comments on my own observations in my specific case. For anyone, planning a trip at high altitude with an existing medical condition, I would always advise them to clear it with their doctor beforehand to make sure they were not at risk and are fit to travel, at the very least as it might invalidate any medical insurance, if you do not.
For context, I am 65 and have suffered some kind of polymyalgia on and off for around 20 years. Diagnosed PMR Nov 2022, began pred at 15mg in Feb 2023, stiffness, pain on moving and fatigue all currently fully controlled on 6mg of pred. I am also asthmatic and significantly over weight. Before the polymyalgia kicked off, I was slim, fit and did several high altitude treks in the Himalaya and Andes, so I have something to compare with. I have done the Everest trail and walked to almost 18,000 ft, the Gosainkund trek to around 15,000 ft, the Jomsom trek, trekked in the Kathmandu valley, Singali La trek at 12,200 ft, and the Inca trail into Machu Picchu, walking to 14,600 ft (apologies for lack of metrication).
The above treks were more than 15 years ago, and although the holiday was vehicle based and not trekking, I was still more than a little apprehensive about how high altitude would affect my PMR, especially because of the extra weight that I am carrying and that it has exacerbated my asthma. And most significantly, I am older. This is a trip that I wanted to do for some years, delayed by the pandemic, and I decided to go for it anyway, since I am not getting younger and my current state of health and fitness may be as good as it gets from now on. Walking and birding are my lifelong loves. So, I just did it!
I went to Bolivia with a very well respected British travel company, who specialise in wildlife adventure holidays, in a group of 9 of us with a birding guide and a driver. It was essentially two holidays run back to back; 9 days in the (so-called) Lowlands (Amazon basin) and 10 days in the Highlands (Andes). Bolivia is an amazing country; fantastic scenery, delightful people and the most amazing birdlife and other nature. The trip was vehicle based, staying in hotels and days out were long with driving in between various birding sites.
Regardless of medical condition, survival at high altitude is entirely dependent on the level to which you are acclimatised. Being out of puff with increased elevation is entirely normal and you soon adjust and should not be confused with Acute Mountain Sickness, which can be fatal if you do not head down when symptoms appear, which is typically around 8-12 hours after passing an individual's acclimatisation limit. Hence, the need to go up slowly to allow time for your body to adjust. The usual recommendation is after 10,000 ft, to sleep at no more than an extra 1,000ft each day, and to walk high and sleep low, since illness usually comes on overnight if you are too high. Excursions to higher levels during the day help acclimatisation. Most people in good health will be fine up to 10K. Acclimatisation rate is independent of age and level of fitness, and is completely unpredictable amongst individuals. Although it is generally acknowledged that tolerance of altitude will reduce with age.
I hadn’t fully appreciated beforehand how well my trip had been designed for acclimatisation. In the first week, we spent 2 nights at 1100m (3,600 ft) and 3 nights at 3300m (10,800 ft). In the highlands, we were at 2,600m (8,500 ft) and 5 nights at 3,600m (12,000 ft) in La Paz. On all legs of the journey, we spent some of each day higher than the level at which we slept with one day out that took us up to a high level pass at 18,000 ft.
So, how did I get on? I would say that my PMR hardly affected my ability to tolerate altitude and I am certain that the altitude did not worsen my PMR, in any way. I do not know if GCA would be affected, as I do not have this atm, that I am aware of. I did suffer some dizziness and some headache when we went up to the summit and my breathing was poor on exertion on the higher level days, although it was clear that I was acclimatising well towards the end of the trip and my breathing was improving greatly. I would say that I was much more impacted by the fact that I am overweight, which has a knock-on effect for my asthma. Certainly, losing a few lbs over the span of the journey seemed to also help. If you allow for that, I would conclude that I probably needed a bit more acclimatisation time to allow for my increased age, but the PMR did not prevent me from completing the trip safely. I experienced no increase in muscular stiffness or pain and 6mg of pred kept me pain free. I did have some problems with my knees, which I have had on and off on pred, and it seems to be soft tissue (not bone). They were fine in weight bearing but got a bit ouchie if I unintentionally twisted my knees slightly when walking, but using trekking poles as a bit of extra support helped me to carry on as normal. My knees are a bit funny anyway and I am suspecting that the pred has softened up the ligaments and tendons.
Birding walks were anything up to 1 or 2 hours and then driving in between sites. I did wonder if the sitting in the vehicle for long periods would be an issue, but I negotiated a seat where I could stretch my legs, which helped. I probably walked around 5-7 miles on some days day, divided up through the day, which is a lot more than I have managed over the last couple of years. I did need to sit out some of the walking by taking a rest in the bus, on occasions, but I am still amazed at how well I managed to keep up, in spite of health issues, and I didn’t miss any birds.
Beforehand, my biggest concern was how I would cope with the fatigue that I had been experiencing, especially as I normally have been sleeping for a couple of hours every afternoon and probably get 10-11 hours sleep in total each day.. They were long days. We were getting up at 4.30 am most days and I was in bed again by 8.30 pm, with very little spare time, except for meal times. I had planned to take days off if I needed them, but I only missed a couple of pre breakfast birding sessions, and on 2 or 3 days, I took a nap on the back seat of the bus during the after lunch birding session. Of course, there was also time for napping when the bus was on the move.
An unexpected bonus was that my neck is completely free of pain and stiffness now, the only difference being that I haven't used the computer for 3 weeks, so I need to be a bit more careful about that going forward.
Overall, I am very pleased with how well I did. I would say that the biggest challenge for anyone doing this kind of trip would be whether the PMR will allow you to do the fitness prep that would enable you to build the stamina to get through. I did little walking before I went, although I was swimming as much as possible to try and build my stamina. I can’t say that I didn’t get tired and perhaps a little grumpy, at times, but I think chubbiness and asthma were bigger handicaps than the PMR, helped by 6mg pred. Since I have been back, I have been catching up on missed sleep, but even so, I feel much fitter and very well, certainly a lot happier and I feel like I have rediscovered my zest for life. It has made me reflect on how much PMR has taken over my life, and going forward, the need to make time and energy for my passions.
Apologies if this is a bit long. I’ve tried to limit it to the impact on health to stay on topic and I hope that someone will find the information useful and maybe encouragement to push your envelope a little. I’m still processing my photos and I have asked if I can share them in the FB gardening group, so that I can talk more about the actual holiday.
P.S. An old post came up beside this and reminded me of something. The lowlands were very hot and humid at the beginning and I remember feeling quite tired and achy right at the beginning of the trip. I improved as we went higher and the temperature and humidity reduced and I am not sure if the better climate was helping or because I was slowly getting fitter. Though I think I might be one of those people whose PMR is aggravated by heat and humidity. In this country, I definitely feel better in the winter than in the summer.
New to pmr advice please 
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